Reimbursement

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Robert H Cofield - One of the best experts on this subject based on the ideXlab platform.

  • cost analysis of revision total hip arthroplasty a 5 year followup study
    Clinical Orthopaedics and Related Research, 1999
    Co-Authors: Robert L Barrack, Jaswin Sawhney, Robert H Cofield
    Abstract:

    A stratified, unselected sample of 30 patients who underwent revision total hip arthroplasty between 1990 and 1992 for whom complete clinical and financial data were available was studied. Clinical data included age, gender, diagnosis, length of stay, operative time and blood loss. Financial data included cost of implants, bone graft and accessories, hospital charge, and surgeon Reimbursement. Results were compared with the results of an analogous group of 50 patients who underwent revision total hip arthroplasty at the same institution between 1995 and 1997. Cases were classified as simple (involving revision of only acetabular liner and/or femoral head), routine (revision of acetabular and/or femoral components), or complex (major structural graft, antiprotrusio cage, impacted grafting). For patients undergoing routine revision total hip arthroplasty, a dramatic decline of 52% occurred in length of stay during the 5-year span (10.7 days to 5.1 days). The average operative time also declined significantly (238 minutes to 199 minutes) as did the average implant cost ($4349 to $2827). Despite this, the average hospital charge increased 16% ($29,666 to $34,328). There was a significant and dramatic 35% decline in surgeon Reimbursement ($3240 to $2178). There was no significant difference in surgeon Reimbursement between simple, routine, and complex total hip arthroplasty. Patients who underwent complex procedures had a significantly greater length of stay (7.3 versus 5.1 days) and operative time (297 versus 199 minutes). The hospital charge was dramatically higher for patients undergoing complex procedures ($51,290 versus $34,328) but the surgeon Reimbursement was lower on average, although not statistically significant ($1926 versus $2178). There was a significant increase in the number and complexity of revision total hip arthroplasties between the two periods. Significant decreases were achieved in length of stay, operating room time, and implant cost. Benefits from these changes were accrued to the hospital but not the surgeon because hospital costs decreased significantly whereas surgeon Reimbursements declined dramatically.

Judy Rosenbloom - One of the best experts on this subject based on the ideXlab platform.

  • Commentary on the Reimbursement paradox.
    Critical care medicine, 2009
    Co-Authors: Nancy L Reaven, Judy Rosenbloom
    Abstract:

    Reimbursement policies are a critical step in the incorporation of new technologies and therapies into the clinical armamentarium. Reimbursement is an umbrella concept describing the process to manage and pay for healthcare services, including benefit coverage, coding, and payment processes. The technologies and services used in therapeutic temperature management are not directly reimbursed, leading to challenges by hospitals and physicians that the services are too expensive to use. The Reimbursement models used in the United States make it increasingly difficult for new technologies and therapies to gain direct Reimbursement, part of a strategy by insurers, including Medicare and private insurance companies, to manage access to health care services. Insurers, physicians, hospitals, and other providers face conflicting financial incentives in current Reimbursement systems. Aligning the financial incentives underlying Reimbursement systems is necessary to adequately support new technologies of merit.

Benjamin Nyblade - One of the best experts on this subject based on the ideXlab platform.

  • Peacekeeping for profit? The scope and limits of ‘mercenary’ UN peacekeeping
    Journal of Peace Research, 2018
    Co-Authors: Katharina P. Coleman, Benjamin Nyblade
    Abstract:

    Developing states furnish the vast majority of UN peacekeeping troops, a fact academics and policymakers often attribute (at least partly) to developing states’ supposed ability to derive a profit from UN peacekeeping Reimbursements. In this article, we argue that this ‘peacekeeping for profit’ narrative has been vastly overstated. The conditions for significantly profiting from UN peacekeeping are in fact highly restrictive, even for developing states. We begin by highlighting two potent reasons for re-examining the peacekeeping for profit narrative: developing states emerged as the UN’s principal troop contributors in a period of stagnant Reimbursement rates when UN peacekeeping was becoming less financially attractive; and the quantitative evidence scholars have presented as supporting the peacekeeping for profit narrative is flawed. We then identify the scope conditions within which peacekeeping for profit provides a plausible explanation for a developing state’s UN troop contributions. First, the deployment and its attendant Reimbursements must be significant not only in absolute and per-soldier terms but also in relation to the state’s total armed forces and military expenditure. Second, the state must have an exceptional ability, compared with other troop contributors, to benefit from UN Reimbursements. The scope for generalized profit-making from either equipment or personnel contributions is limited by intense political pressure against Reimbursement rate increases. Individual states can nevertheless make a profit if they (1) invest in inexpensive and old but functional equipment, especially if deployed with usage restrictions, and/or (2) limit the deployment allowances (rather than salaries) they pay their peacekeepers. We establish that only a limited subset of developing states meets the plausibility conditions for the peacekeeping for profit narrative – and many top UN troop contributors do not.

  • peacekeeping for profit the scope and limits of â mercenaryâ un peacekeeping
    Journal of Peace Research, 2018
    Co-Authors: Katharina P. Coleman, Benjamin Nyblade
    Abstract:

    Developing states furnish the vast majority of UN peacekeeping troops, a fact academics and policymakers often attribute (at least partly) to developing states’ supposed ability to derive a profit from UN peacekeeping Reimbursements. In this article, we argue that this ‘peacekeeping for profit’ narrative has been vastly overstated. The conditions for significantly profiting from UN peacekeeping are in fact highly restrictive, even for developing states. We begin by highlighting two potent reasons for re-examining the peacekeeping for profit narrative: developing states emerged as the UN’s principal troop contributors in a period of stagnant Reimbursement rates when UN peacekeeping was becoming less financially attractive; and the quantitative evidence scholars have presented as supporting the peacekeeping for profit narrative is flawed. We then identify the scope conditions within which peacekeeping for profit provides a plausible explanation for a developing state’s UN troop contributions. First, the deployment and its attendant Reimbursements must be significant not only in absolute and per-soldier terms but also in relation to the state’s total armed forces and military expenditure. Second, the state must have an exceptional ability, compared with other troop contributors, to benefit from UN Reimbursements. The scope for generalized profit-making from either equipment or personnel contributions is limited by intense political pressure against Reimbursement rate increases. Individual states can nevertheless make a profit if they (1) invest in inexpensive and old but functional equipment, especially if deployed with usage restrictions, and/or (2) limit the deployment allowances (rather than salaries) they pay their peacekeepers. We establish that only a limited subset of developing states meets the plausibility conditions for the peacekeeping for profit narrative – and many top UN troop contributors do not.

Paweł Kawalec - One of the best experts on this subject based on the ideXlab platform.

  • Pharmaceutical Regulation in Central and Eastern European Countries: A Current Review.
    Frontiers in Pharmacology, 2017
    Co-Authors: Paweł Kawalec, Tomas Tesar, Lenka Vostalova, Pero Draganić, Manoela Manova, Alexandra Savova, Guenka Petrova, Zinta Rugaja, Agnes Männik, Christoph Sowada
    Abstract:

    Objectives: The aim of this study was to review Reimbursement environment as well as pricing and Reimbursement requirements for drugs in selected Central and Eastern Europe (CEE) countries. Methods: A questionnaire-based survey was performed in the period from November 2016 to March 2017 among experts involved in Reimbursement matters from CEE countries: Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Slovakia, and Romania. A review of requirements for Reimbursement and implications of Health Technology Assessment (HTA) was performed to compare the issues in above-mentioned countries. For each specified country, data for Reimbursement costs, total pharmaceutical budget, and total public health care budget in the years 2014 and 2015 were also collected. Questionnaires were distributed via emails and feedback data were obtained in the same way. Additional questions, if any, were also submitted to respondents by email. Pricing and Reimbursement data were valid for March 2017. Results: The survey revealed that the relation of drug Reimbursement costs to total public healthcare spending ranged from 0.12 to 0.21 in the year 2014 and 2015 (median value). It also revealed that pricing criteria for drugs, employed in the CEE countries, were quite similar. External reference pricing as well as internal reference pricing were common in mentioned countries. Positive Reimbursement lists were valid in all countries of the CEE region, negative ones were rarely used; Reimbursement decisions were regularly revised and updated in the majority of countries. Copayment was common and available levels of Reimbursement differed within and between the countries and ranged from 20% to 100%. Risk-sharing schemes were often in use, especially in the case of innovative, expensive drugs. Generic substitution was also possible in all analyzed CEE countries, while some made it mandatory. HTA was carried out in almost all of the considered CEE countries and HTA dossier was obligatory for submitting a pricing and Reimbursement application. Conclusions: Pricing and Reimbursement requirements are quite similar in the CEE region although some differences were identified. HTA evaluations are commonly used in considered countries.

  • Implementation of the 2011 Reimbursement Act in Poland: Desired and undesired effects of the changes in Reimbursement policy
    Health policy (Amsterdam Netherlands), 2016
    Co-Authors: Paweł Kawalec, Anna Sagan, Ewa Stawowczyk, Iwona Kowalska-bobko, Anna Mokrzycka
    Abstract:

    The Act of 12 May 2011 on the Reimbursement of Medicines, Foodstuffs Intended for Particular Nutritional Uses and Medical Devices constitutes a major change of the Reimbursement policy in Poland. The main aims of this Act were to rationalize the Reimbursement policy and to reduce spending on reimbursed drugs. The Act seems to have met these goals: Reimbursement policy (including pricing of reimbursed drugs) was overhauled and the expenditure of the National Health Fund on reimbursed drugs saw a significant decrease in the year following the Act's introduction. The annual savings achieved since then (mainly due to the introduction of risk sharing schemes), have made it possible to include new drugs into the Reimbursement list and improve access to innovative drugs. However, at the same time, the decrease in prices of reimbursed drugs, that the Act brought about, led to an uncontrolled outflow of some of these drugs abroad and shortages in Poland. This paper analyses the main changes introduced by the Reimbursement Act and their implications. Since the Act came into force relatively recently, its full impact on the Reimbursement policy is not yet possible to assess.

Robert L Barrack - One of the best experts on this subject based on the ideXlab platform.

  • cost analysis of revision total hip arthroplasty a 5 year followup study
    Clinical Orthopaedics and Related Research, 1999
    Co-Authors: Robert L Barrack, Jaswin Sawhney, Robert H Cofield
    Abstract:

    A stratified, unselected sample of 30 patients who underwent revision total hip arthroplasty between 1990 and 1992 for whom complete clinical and financial data were available was studied. Clinical data included age, gender, diagnosis, length of stay, operative time and blood loss. Financial data included cost of implants, bone graft and accessories, hospital charge, and surgeon Reimbursement. Results were compared with the results of an analogous group of 50 patients who underwent revision total hip arthroplasty at the same institution between 1995 and 1997. Cases were classified as simple (involving revision of only acetabular liner and/or femoral head), routine (revision of acetabular and/or femoral components), or complex (major structural graft, antiprotrusio cage, impacted grafting). For patients undergoing routine revision total hip arthroplasty, a dramatic decline of 52% occurred in length of stay during the 5-year span (10.7 days to 5.1 days). The average operative time also declined significantly (238 minutes to 199 minutes) as did the average implant cost ($4349 to $2827). Despite this, the average hospital charge increased 16% ($29,666 to $34,328). There was a significant and dramatic 35% decline in surgeon Reimbursement ($3240 to $2178). There was no significant difference in surgeon Reimbursement between simple, routine, and complex total hip arthroplasty. Patients who underwent complex procedures had a significantly greater length of stay (7.3 versus 5.1 days) and operative time (297 versus 199 minutes). The hospital charge was dramatically higher for patients undergoing complex procedures ($51,290 versus $34,328) but the surgeon Reimbursement was lower on average, although not statistically significant ($1926 versus $2178). There was a significant increase in the number and complexity of revision total hip arthroplasties between the two periods. Significant decreases were achieved in length of stay, operating room time, and implant cost. Benefits from these changes were accrued to the hospital but not the surgeon because hospital costs decreased significantly whereas surgeon Reimbursements declined dramatically.